pacemaker therapy Flashcards
what are the indications for a pacemaker? in bradycardic patients
patient has a slower than normal impulse formation of a symptomatic AV or ventricular conduction disturbance
what are the indications for a pacemaker? in tachycardic patients
patients have a tachydysrhythmic heart rate that cannot be controlled by medications
they need a biventricular pacemaker that is used to resynchronize the heart
what are the indications for a pacemaker for someone who is in advanced heart failure?
they have a biventricular pacemaker that resynchronizes the heart, this may include the ICD in patients
two pieces of a pacemaker
pulse generator (outside of heart that houses the batteries) Leads (electrical wires that stimulate the heart)
temporary pace makers have a pulse generator that controls what?
rate
strength
sensitivity
rate
beats per minutes
strength
amount of electrical stimulus that is sent to the heart
sensitivity
the amount of intracardiac activity that needs to be sensed by the electrodes for an impulse to sensed by the decide
what are the indications for a temporary pacer
MIS (if they are on beta blockers that slow the heart), emergent situations and elective medical procedures
how long does a permeant pacer last?
6 to 12 years
what will need to be adjusted on a persons permanent pace maker?
Rate, sensitivity, strength
how does the generator function?
pace maker spikes when it doesn’t detect a beat for a certain amount of time
what is need to be done prior to dc of a someone with pacemaker procedure
cxr to confirm placement
no pnuemothorax
document position of the leads
ECG pace maker spikes
look different cause the electrical impulse of the heart does not come from the same place
cardiologists pick a pacemaker based on what criteria?
patients dysrhythmia
underlying cardiac function
age
Bi ventricular pacing is indicated by?
conduction disturbances
widened QRS greater than 120
ej is less than 35 %
not likely to improve with medications
complications of pacemaker implanation
infection at site
dislodged or fractured leads
pacers that dont sense properly
inappropriate delivery of ICD
minimizing patient activity can help prevent complication
patients can reprogram pacers over the phone
data for pt record of pace maker
type of pacemaker type of generator date and time of insertion location of pulse generator stimulation thershold pacer settings
most common complications of pacemaker
bradycardia and decreased cardiac out put
indications of ICD
high risk for VT
high risk for VF
survived sudden cardiac death caused by VF
patients who are CHF and 40 days post MI with moderate or severe LV dysfunction
patients can feel the shock
how does an ICD work?
monitors heart rhythm identifies and defibrillates in order to get back to sinus rhythm Includes anti-tachycardic cardioversion defib bradycardia pacing
initial post op mangment of ICD placement
bleeding
hematoma
infection
assess activation status of device, heart rate
report throbbing pain to healthcare provider
prior to dc of ICD placement
cxr pneumo and lead placement
no movement
cardiologists pick a pacemaker based on what criteria?
patients dysrhythmia
underlying cardiac function
age
